This review examined the clinical effectiveness of using IVIg in the management of patients with ITP, compared with other active treatments or placebo.
For acute ITP in children, inconsistent results were reported across studies regarding IVIg superiority in the early recovery of profound thrombocytopenia. Our quantitative synthesis shows significant differences in the proportion of patients with platelet counts greater than or equal to 20Q109/L at 24 hours, 48 hours, and 72 hours after the start of treatment, in favour of IVIg compared with corticosteroids. In adult patients with profound thrombocytopenia, the effect of IVIg on clinical outcomes remains indeterminate. Sparse evidence indicates that IVIg may be more efficacious in improving platelet counts in the short term than corticosteroids but possibly at the risk of more SAEs.
Until further adequately powered and controlled trials are available, the clinical impact of choosing these agents versus available alternatives in most situations remains uncertain. For acute ITP in children, our findings showed that IVIg (0.8 g/kg/day to 1 g/kg/day over one to two days) is more efficacious than corticosteroids in terms of the early improvement of thrombocytopenia to platelet counts greater than or equal to 20Q109/L. The role of IVIg in chronic childhood ITP could not be established because evidence from scant, poorly designed, and poorly reported randomized controlled trials could not be synthesized. There are insufficient data to determine whether IVIg has an advantage over other interventions in the long-term management of adult ITP. Finally, there is insufficient evidence to identify subgroups of ITP patients who may preferentially benefit from IVIg.
